TasP and the Importance of Starting HIV Treatment Immediately Upon Diagnosis

If a long, healthy life isn’t reason enough to get you motivated to be tested and treated for HIV, consider this: It’s not just about you anymore.

News out of the International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Vancouver, Canada underscores what doctors and scientists already have been saying for a while now: Starting antiretroviral therapy (ART) immediately after a positive HIV diagnosis drastically wards off health complications down the road. Not only that, it also reduces transmission of the virus to another person.

Data from the Strategic Timing of AntiRetroviral Treatment (START) study showed that ART does more than fend off serious AIDS-related diseases. It also prevents cancer, cardiovascular disease, and other non-AIDS related diseases in people with HIV.

The START results first were announced in May, but new data shows the risk of developing serious AIDS-related illness or death was reduced 57 percent among those who started treatment early compared to volunteers where treatment was deferred. The reduction was seen independent of age, sex, CD4 cell counts at start of therapy, or income.

In December 2013, research published in PLOS One showed Caucasian gay men diagnosed with HIV at age 20 could live as long as a non-infected person – to an average age of 77. But that study was limiting, because gay men tend to get tested more regularly. The racial disparity also could have been reflective of socioeconomic status, the researchers concluded.

But the START study, which included 4,685 HIV-infected men and women ages 18 and older from 35 countries, showed starting antiretroviral therapy early not only prevented serious AIDS-related diseases, but also prevented the onset of cancer, cardiovascular disease, and other non-AIDS-related diseases.

“The results show that early treatment not only reduces opportunistic infections, which offers a bigger benefit in lower-income countries, but it also prevents a significant amount of illness in higher-income countries as well by reducing the risk of serious non-AIDS events that consisted largely of cancer and cardiovascular disease,” said Dr. Jens Lundgren of the University of Copenhagen and one of the co-chairs of the START study, in a news release issued by the National Institutes of Health (NIH).

Non-AIDS-related events tracked by the study included cardiovascular disease, end-stage renal disease, liver disease, non-AIDS defining cancer or causes of death not attributable to AIDS, according to the news release. Serious AIDS events were reduced by 72 percent and serious non-AIDS events were reduced by 39 percent.

“This study conclusively shows that the benefits of early therapy far outweigh any adverse outcomes, and reinforces recommendations to offer immediate antiretroviral therapy to all patients,” said NIAID Director Dr. Anthony S. Fauci. “Today’s findings show that early antiretroviral treatment presents no additional risk of serious, non-AIDS-related disease to people taking treatment, but actually confers valuable protection against these illnesses, helping keep HIV-infected people healthier longer.”

TasP Takes the Spotlight.

Research presented Monday also underscored the concept of “Treatment as Prevention,” or TASP.

People with HIV who adhere to their treatment and suppress the virus reduce the changes of transmission to their partner by 93 percent.

The finding comes from the decade-long HPTN 052 clinical trial funded primarily by the NIH.

“The study now makes crystal clear that when an HIV-infected person takes antiretroviral therapy that keeps the virus suppressed, the treatment is highly effective at preventing sexual transmission of HIV to an uninfected heterosexual partner,” said Fauci. “For heterosexuals who can achieve and maintain viral suppression, the risk to their partners is exceedingly low.”

Last year, a study called the PARTNER study demonstrated zero transmissions out of 30,000 sex acts where the positive partner was on ART. The study included both men who have sex with men and heterosexual couples. The partners did not use condoms in the European study and the negative partner did not take PrEP, according to a story published by Healthline News.

The study enrolled almost 1,800 heterosexual, sero-mixed partners from Botswana, Brazil, India, Kenya, Malawi, South Africa, Thailand, the United States and Zimbabwe in 2005. The couples were given condoms and safer sex education counseling.

Positive partners randomly were assigned to begin ART right away, or ART was delayed until onset of an AIDS-defining illness or otherwise weakened immune system based on World Health Organization guidelines at that time.

Only eight cases of transmission were reported among couples where the positive partner received ART.

The investigators found that among the HPTN 052 participants who started antiretroviral therapy early but failed treatment before May 2011, those who had a higher viral load when they joined the study were likely to develop resistance to their antiretroviral drugs, the news release stated. Additional analysis is needed to clarify this association, according to the investigators.

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